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Mastering Patient Care Fundamentals 200 NCLEX-Style Questions | Answers &

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Mastering Patient Care Fundamentals 200 NCLEX-Style Questions | Answers & Question 1. A patient is prescribed 1000 mL of lactated Ringer’s to infuse over 8 hours. The drop factor is 20 gtt/mL. What is the flow rate in gtt/min? A. 21 gtt/min B. 31 gtt/min C. 42 gtt/min D. 52 gtt/min Correct Answer: C Rationale: (1000 × 20) ÷ (8 × 60) = 20,000 ÷ 480 = 41.67 → 42 gtt/min. Question 2. The nurse enters a patient’s room and finds the patient on the floor next to the bed. After calling for help, what is the nurse’s priority action? A. Perform a head-to-toe assessment B. Help the patient back to bed C. Complete an incident report D. Check the patient’s blood pressure Correct Answer: A Rationale: Assess for injury first (head trauma, fractures, bleeding) before moving the patient. Question 3. Which vital sign in a postoperative patient requires immediate intervention? A. Blood pressure 110/70 mmHg B. Pulse 92 bpm C. Respiratory rate 8 breaths/min D. Temperature 99.0°F (37.2°C) Correct Answer: C Rationale: Respiratory rate of 8 is bradypnea, indicating respiratory depression; requires immediate action. Question 4. An immobile patient is at risk for pressure injuries. The nurse should reposition the patient at which interval? A. Every 1 hour B. Every 2 hours C. Every 4 hours D. Every shift Correct Answer: B Rationale: Repositioning every 2 hours is the standard for pressure injury prevention. Question 5. A patient with a new ileostomy reports watery output. What is the nurse’s best response? A. “This is expected; ileostomy output is always liquid.” B. “Let me check your medications and recent diet.” C. “You should eat more bananas and applesauce.” D. “Decrease your fluid intake to thicken the output.” Correct Answer: B Rationale: Assess for causes like infection, medications, or dietary changes before recommending interventions. Question 6. Which intervention is most effective for preventing falls in a confused elderly patient? A. Apply bilateral wrist restraints B. Keep all four bed rails up C. Place the patient in a room near the nurses’ station with a bed alarm D. Administer a sedative at bedtime Correct Answer: C Rationale: Bed alarms and proximity to staff enhance safety without the risks of restraints or sedatives. Question 7. A patient refuses a blood transfusion. What should the nurse do? A. Administer it and document the refusal later B. Ask the family to convince the patient C. Respect the refusal, document, and notify the provider D. Offer to delay the transfusion by 2 hours Correct Answer: C Rationale: Competent adults have the right to refuse treatment; respect autonomy and notify the provider.

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Mastering Patient Care Fundamentals

200 NCLEX-Style Questions | Answers &




Question 1. A patient is prescribed 1000 mL of lactated Ringer’s to infuse
over 8 hours. The drop factor is 20 gtt/mL. What is the flow rate in gtt/min?

A. 21 gtt/min

B. 31 gtt/min

C. 42 gtt/min

D. 52 gtt/min

Correct Answer: C ✓

Rationale: (1000 × 20) ÷ (8 × 60) = 20,000 ÷ 480 = 41.67 → 42 gtt/min.




Question 2. The nurse enters a patient’s room and finds the patient on the
floor next to the bed. After calling for help, what is the nurse’s priority
action?

A. Perform a head-to-toe assessment

B. Help the patient back to bed

C. Complete an incident report

D. Check the patient’s blood pressure

Correct Answer: A ✓

Rationale: Assess for injury first (head trauma, fractures, bleeding) before
moving the patient.




Question 3. Which vital sign in a postoperative patient requires immediate
intervention?

,A. Blood pressure 110/70 mmHg

B. Pulse 92 bpm

C. Respiratory rate 8 breaths/min

D. Temperature 99.0°F (37.2°C)

Correct Answer: C ✓

Rationale: Respiratory rate of 8 is bradypnea, indicating respiratory
depression; requires immediate action.




Question 4. An immobile patient is at risk for pressure injuries. The nurse
should reposition the patient at which interval?

A. Every 1 hour

B. Every 2 hours

C. Every 4 hours

D. Every shift

Correct Answer: B ✓

Rationale: Repositioning every 2 hours is the standard for pressure injury
prevention.




Question 5. A patient with a new ileostomy reports watery output. What is
the nurse’s best response?

A. “This is expected; ileostomy output is always liquid.”

B. “Let me check your medications and recent diet.”

C. “You should eat more bananas and applesauce.”

D. “Decrease your fluid intake to thicken the output.”

Correct Answer: B ✓

,Rationale: Assess for causes like infection, medications, or dietary changes
before recommending interventions.




Question 6. Which intervention is most effective for preventing falls in a
confused elderly patient?

A. Apply bilateral wrist restraints

B. Keep all four bed rails up

C. Place the patient in a room near the nurses’ station with a bed alarm

D. Administer a sedative at bedtime

Correct Answer: C ✓

Rationale: Bed alarms and proximity to staff enhance safety without the risks
of restraints or sedatives.




Question 7. A patient refuses a blood transfusion. What should the nurse do?

A. Administer it and document the refusal later

B. Ask the family to convince the patient

C. Respect the refusal, document, and notify the provider

D. Offer to delay the transfusion by 2 hours

Correct Answer: C ✓

Rationale: Competent adults have the right to refuse treatment; respect
autonomy and notify the provider.




Question 8. Which laboratory value is within normal limits for an adult?

A. Potassium 5.8 mEq/L

B. Sodium 136 mEq/L

, C. Hemoglobin 11 g/dL

D. Platelets 100,000/mm³

Correct Answer: B ✓

Rationale: Normal sodium is 135–145 mEq/L. Potassium 5.8 is hyperkalemia;
Hgb 11 is low; platelets 100,000 is low.




Question 9. A patient drinks 12 oz of coffee. How many mL should the nurse
document?

A. 240 mL

B. 300 mL

C. 360 mL

D. 480 mL

Correct Answer: C ✓

Rationale: 1 oz = 30 mL; 12 × 30 = 360 mL.




Question 10. Which patient has the highest risk for developing a DVT?

A. A patient with a fractured tibia in a cast

B. A patient who is 2 days post-total knee replacement

C. A patient with pneumonia

D. A patient with gastroenteritis

Correct Answer: B ✓

Rationale: Major orthopedic surgery, immobility, and hypercoagulability are
significant DVT risk factors.

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